Dealing with severe epilepsies

February 2017
Epilepsy, which affects several hundred thousand British people today, is a disability.

Characterised by repetitive and chronic epileptics fits, in its severe form, things become a little more complicated. The patient is then considered to have a long-term disability and must be cared for.


Diagnosing a severe epilepsy



Several criteria can determine if a patient suffers from a severe epilepsy:
  • Cognitive, psycho-affective, family, educational, school or professional repercussions of the disease;
  • The frequency, nature and resistance to the treatment of the crises;
  • Undesirable effects of the treatment.


Various means to establish an initial evaluation:
  • Orientation and antecedents factors
    • Age of first fits, patient's medical and family history
    • Interrogation of the patient
      • Description of the fits ("short, stereotyped and repetitive symptoms must draw the attention");
      • Former neurological episode
      • Starting factors
      • Frequency and schedule of the crises
    • Neurological examination (neuropsychologist)
    • Different EEG (nap, ambulatory, night...)
    • MRI, SPECT, TEP...
    • Metabolic and genetic examinations (in the child)
    • Neuropsychological assessment (psychological)

Treatment


Once the diagnosis is established, by a neuro-paediatrician or a neurologist, the patient must be cared for. This consists in the following:
  • A antiepileptic treatment
    • Pharmacological treatment for a fit with loss of consciousness: recovery position + benzodiazepine by rectal or oral way when the crisis lasts more than 3 minutes, young subjects only.
    • Basic pharmacological treatment: antiepileptic associated, depending on certain syndromes, with corticoids or piracetam.
    • Other treatments
      • Surgery
      • Ketogenetic diet (diet based on fat, low in proteins and carbohydrate which is recognised as being anticonvulsive; requires hospitalisation)
    • Treating complications
      • Anxio-depressive, behaviour disorders: antidepressants, neuroleptics
      • Vitamin therapy (vitamin D)
      • Contraception for adolescents and women (recommended)
      • Folic acid (pregnancy)
    • Help in rehabilitation (family, social...)
    • Detection of and dealing with co-morbidities and complications
    • Help to improve quality of life


Therapeutic information must be combined with pharmacological treatment. The patient will:
  • Be informed about the existence of epileptic people associations;
  • Understand his disease;
  • Be informed on his disease, treatments and their consequences;
  • Adopt a healthy lifestyle (reduce or stop drinking alcohol);
  • Plan consultations;
  • Know the inherent risks of pregnancy and be informed on contraception, for adolescents and women.

Follow-up


The follow-up of patients affected by severe epilepsy is advised:
  • To prevent spontaneous or iatrogenic complications;
  • To supervise and adapt the treatment;
  • To help professional, social or school rehabilitation;
  • To accompany the patient and his entourage (therapeutic information...);
  • To ensure the transition between dealing with a child suffering from a severe epilepsy to dealing with him as an adult.


The follow-up is clinical - to detect the undesirable effects of the treatment, to prevent pregnancy... - and paraclinical (biological examinations, MRI, EEG...).

Sources


To download a number of patient guides on severe epilepsy.

Photographic copyright: © OOZ - Fotolia.com

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